omar m. al-rawajfah, phd, rn 2 nd international conference on nursing & healthcare november...

Jordanian icu registered nurses: are they compliant with standard infection control practices?

Omar M. AL-Rawajfah, PhD, RN

2nd International Conference on

Nursing & Healthcare November 17-19 2014, Chicago USA

ACKNOWLEDGEMENTS

Authors would like to acknowledge:◦ The Scientific Research Support Fund at

the Jordanian Ministry of Higher Education and Scientific Research for funding this project (Grant ID: 2010/03/1).

◦ Deanship of Research at Al AL-Bayt University- Jordan for funding this presentation



BACKGROUND AND SIGNIFICANCE Prevalence of Healthcare Associated Infections

(HCAIs) in intensive care units (ICUs) are much higher than other units

Assessment of adherence to infection control guidelines periodically is a high priority measure to reduce the incidence of HCRIs (CDC, 2002)

No Jordanian Studies that assess IC practice among ICU nurses at the national level



STUDY OBJECTIVES The purpose of this national study

was to assess the compliance of Jordanian ICU RNs with standard IC guidelines

Identify possible factors that affect Jordanian ICU RN compliance with IC guidelines

Identify possible differences in IC practices among RNs in different healthcare sectors in Jordan



METHODOLOGY This study used a descriptive cross-sectional

design

Proportional, multistage, probability sampling was used

The sampling frame consisted of all Jordanian hospitals listed by the Ministry of Health annual statistical report

The total sampling frame consisted of 103 hospitals (29.1% were governmental, 10.7% military, 58.3% private and 1.9% university affiliated hospitals)



STUDY INSTRUMENT The Infection Control Practices Tool (ICPT)

◦ 29 items and uses a 5-point Likert scale◦ Score ranged from 29 to 145

Reliability coefficient of the Arabic version in this study was 0.88

Three level of compliance:◦ Unsafe compliance (less than the 50th percentile )◦ Weak compliance (between the 50th to 75th

percentiles) ◦ High compliance (more than 75th percentile)



DATA ANALYSIS We used SPSS®-PC Version 20.

Reliability coefficient of the Arabic version in this study was 0.88

Missing data for the 29 practice items ranged from 1% to 3%.

The expectation-maximization (EM) maximum likelihood algorithm was used to impute missing data for all practice items.

Cases of missing data of 20% or greater were excluded from the final analysis



RESULTS 21 Hospitals participated in the study

◦ 8 Governmental, 7 Military, 4 Private, & 2 university

affiliated.

◦ The final sample consisted of 247 RNs from 56 critical

care units. Sample characteristics

◦ 51% female with a mean age of 28.5 years (SD = 5.2).

◦ 84.6% held a BSN degree with mean years of experience of

6.2 years (SD = 5.1)

◦ 37.6% worked in medical and surgical floors and 20% worked

in critical care units

◦ 54.7% of RNs were working in general ICUs; 17.8 % worked

in NICUs; only about 2.8% were working in cardiac

catheterization units

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RESULTS The mean overall compliance level

was 122.6 (SD = 13.2)◦ Unsafe compliance (2.7%)◦ Weak compliance (22.8%) ◦ High compliance (74.5% )

Important Infection Control Practices◦ 78.9% always washed their hands before giving care to

patients

◦ 63.2% always wash their hands before and after gloving

◦ 24.3% always share equipments between patients

without sterilization

◦ 52.4% perform recapping always or most of the time

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Un-safe

Weak High020406080



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Yes No or not

sure

M (SD) M (SD) t (df) p

value

Receive infection control training

inside the hospital

124.3 (12.3) 117.3

(14.6)

3.7 (245) < 0.001

Receive infection control training

outside the hospital

126.2 (11.7) 121.8

(13.4)

2.0 (244) 0.05

Hospital offer IC education for new

nurses

123.6 (12.3) 115.6

(16.8)

3.2 (244) 0.002

Received hepatitis B vaccine 123.2 (12.5) 119.4

(15.8)

1.7 (245) 0.08

COMPARED MEANS COMPLIANCE SCORE IN RELATION TO SELECTED FACTORS



RESULTS One-way ANOVA

◦ Total compliance scores were NOT significantly different across all types of healthcare sectors, F (3, 246) = 0.60, p < 0.70.

◦ The mean total IC practice score was not statistically different across all types of critical care units, F (6, 246) = 0.80, p < 0.90.

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DISCUSSION Strengths of the study

◦ This is the first Jordanian national study that evaluated IC practices among ICU RNs.

◦ Inclusion of hospitals representing all health care sectors in Jordan from all geographical areas

◦ Proportional probability sample, results are very likely generalizable

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DISCUSSION Limitations of the study

◦ Use of a self-report method.

◦ Self-report method overestimates the compliance rate with IC practices in comparison with the observation

◦ The use of observation would give greater insight regarding level of compliance with these guidelines

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DISCUSSION Massages to healthcare sectors

◦ 63.7% of untrained nurses worked in governmental and military hospitals

◦ 74% of nurses with weak compliance worked in governmental and military hospitals

◦ Orientation and teaching programs conducted in hospitals for newly employed RNs

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DISCUSSION Massages to healthcare sectors

◦ 24.3 % always or most of the time shared equipment between patients

The availability of IC resources such as hand washing facilities and personal protective equipment in health care facilities in Jordan represents a real challenge.

Recent standard recommended a ratio of 0.8 to 1.0 IC-nurses per 100 occupied acute care beds as an appropriate level of IC staffing

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THANK YOU……

WE ARE READY FOR YOUR IMPORTANT

QUESTION

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omar m. al-rawajfah, phd, rn 2 nd international conference on nursing & healthcare november...

Documents

jordanian hospitals

jordanian icu rn compliance

infection control guidelines

jordanian studies

national study

unsafe compliance

level of compliance

chicago usaresults21